[Sphincter of Oddi motility disturbances--etiologic factor or the consequence of choledocholithiasis]

Abstract

Choledocholithiasis is often found in patients after cholecystectomy done previously for cholelithiasis.

Aim: To evaluate the effects of cholecystectomy and common bile stones' presence on sphincter of Oddi (SO) motility.

Material: 13 patients with common bile duct stones (2 men and 11 women, age 54 to 85 yrs) were studied. They were divided in two groups: A--6 pts age 54 to 85 yrs (with biliary lithiasis) and group B of 7 pts age 55-71 after cholecystectomy. Cholecystectomized group was further divided into 2 groups according to administration (B1 group) or not (B2) a premedication.

Method: Sphincter of Oddi manometry was done in all patients as the part of routine ERCP. A water-perfused, low-compliance, triple-lumen manometric system (Synectics Medical Sweden) was used to record the SO tonic and phasic activity. Common bile duct (CBD) pressure, basal SO pressure, SO phasic contractions frequency, duration and amplitude as well as direction of propagation peristaltic waves, motility index (MI) and AuC (area under curve) were measured.

Results: The CBD pressure, the basal SO pressure and the frequency of phasic SO waves tended to be lower in patients after cholecystectomy (p > 0.05). We observed profound changes in the motility pattern of SO phasic activity. There was significantly less anterograde and more retrograde waves in patients from group B than A (18.9% vs. 68.8%; p < 0.01 and 52.4% vs. 10.4% respectively; p = 0.01). In the group B1 comparing with group B2 we found significant decrease of frequency (1.8/min +/- 0.53 vs. 3.3/min +/- 0.77; p < 0.05) and increase of the mean amplitude of phasic SO activity (223.2 mmHg +/- 22.9 vs. 137.3 mmHg +/- 25.0; p < 0.01). The duration of pressure waves was prolonged (with long "plateau" or multipeaked) with rapid pressure increase, what resulted in high AuC index (1155.61 +/- 100.42 vs. 515.23 +/- 210.9; p < 0.01). However no difference in MI was observed.

Conclusion: Our results confirm hypothesis that cholecystectomy influences the pattern of phasic SO motility. Moreover increased percent of retrograde propagation of SO phasic contractions probably contributes to subsequent common duct stones development rather than being the consequences of their presence.